| Eau Claire Cooperative Health Center, Inc. | |
|
3041 Old Eastover Road Eastover SC 29044-2417 | |
| (803) 353-8741 | |
| (803) 353-8789 |
| Full Name | Eau Claire Cooperative Health Center, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 3041 Old Eastover Road, Eastover, South Carolina |
| Authorized Official Name and Position | Delgado Cantave (CEO) |
| Authorized Official Contact | 8037335969 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Eau Claire Cooperative Health Center, Inc. Po Box 3788 Columbia SC 29230-3788 Ph: (803) 733-5969 | Eau Claire Cooperative Health Center, Inc. 3041 Old Eastover Road Eastover SC 29044-2417 Ph: (803) 353-8741 |
| NPI Number | 1811294978 |
|---|---|
| Provider Enumeration Date | 02/24/2011 |
| Last Update Date | 02/10/2022 |
| Medicare PECOS PAC ID | 3274434220 |
|---|---|
| Medicare Enrollment ID | O20120622000332 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811294978 | NPI | - | NPPES |
| CBP018 | Medicaid | SC | |
| FQC031 | Medicaid | SC | |
| FQC132 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (South Carolina) | Primary |